Page 79 - Magyar Gasztroenterológiai Társaság 2020. november 6–7. – ONLINE KONGRESSZUS

Előadáskivonatok / Abstracts

Introduction: Endoscopic retrograde Results: Successful cannulation in all native papilla cases
cholangiopancreatography (ERCP) is recommended in with biliary indications were achieved in 1709/1871 (91.3%)
acute biliary pancreatitis (ABP) when cholangitis or ongoing cases. The success rate was 85.9% (650/756) if advanced
common bile duct obstruction is present. The inflammation of cannulation cases were considered. In 207 cases pancreatic
the pancreas and the surrounding tissues might make the guidewire and in 549 cases a precut method was used
procedure more difficult. primarily. The most used double guidewire and
Aims: We aimed to compare the outcomes and difficulty of transpancreatic sphincterotomy techniques achieved a high
ERCP in ABP and acute cholangitis (AC) in prospectively and comparable success rate with the use of salvage
collected data of 7 Hungarian tertiary centers. methods (53/56, 96.6% vs. 71/72, 98.6%, without: 41/56,
Methods: 240 ABP cases and 250 AC cases without ABP 73.2% vs. 60/72, 83.3%) low PEP rate (0/56, 0% vs. 3/72,
were analyzed. Previous papillotomy altered gastroduodenal 4.17%), bleeding rate (1/56, 1.8% vs. 1/72, 1.4%) and
anatomy, and cases with biliary stricture were excluded. The cannulation time (639 vs. 443 s). While in the primary precut
rate of successful biliary access, advanced cannulation group, needle knife fistulotomy had higher success rate
method, adverse events as well as cannulation and compared to traditional needle knife precut (74/82, 90.2% vs.
fluoroscopy time and subjective difficulty were compared. 353/427, 82.7%, without salvage methods: 74/82, 90.2% vs.
Results: No difference was found between biliary 347/427, 81.3%), similar PEP (3/82, 3.7% vs. 13/427, 3.0%),
cannulation rates in the two groups (95.8% vs. 97.2%, bleeding rates (0/82, 0% vs. 7/427, 1.6%), and cannulation
p=0.409). Significantly more pancreatic guidewire time (512 vs. 412 s). PEP developed in 2 TPS and 4 NKPP
manipulation (31.3% vs. 17.2%; p<0.001) and prophylactic cases where no pancreatic stent and indomethacin
pancreatic stent use (19.6% vs. 4.8%; p<0.001) were seen in suppositories were used and could have been prevented.
the ABP than in AC group. Moreover, longer cannulation time Conclusion:Generally good outcomes in terms of biliary
in the ABP patients (248 vs. 185 s; p=0.043) and higher cannulation success, low PEP and bleeding rates were
fluoroscopy times (91 vs. 107 s; p=0.009) in the AC group achieved even in the difficult cannulation setting according to
were measured. There was no significant difference between our data. However, not all opportunities to prevent PEP were
the rate of adverse events and subjective difficulty. utilized, highlighting the potential need for improvement.
Conclusion: ERCP in ABP cases is more challenging than 119. POST-ERCP COMPLICATIONS IN OUR
in AC but it does not affect the outcomes. The higher DEPARTMENT AFTER 500 EXAMINATIONS.
frequency of difficult biliary cannulation in the ABP patients EFFECTIVENESS OF RECTAL INDOMETHACIN IN
warrants the involvement of an experienced endoscopist. PROFILAXIS OF POST-ERCP PANCREATITIS.
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Pécsi D. , Tóth L. , Magyarosi D. , Sepsi B. , Balog I. , Kokas
118. ADVANCED BILIARY CANNULATION STRATEGIES M. , Pécsi G.
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IN TERTIARY CENTERS – ANALYSIS OF 1871 NATIVE 1. Karolina Kórház - Rendelőintézet, Mosonmagyaróvár
PAPILLA CASES FROM THE HUNGARIAN ERCP
REGISTRY Introduction: The benefits of ERCP are well known,however
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Pécsi D. , Gódi S. , Hegyi P. , Altorjay I. , Bakucz T. , is some cases we must reckon with complications.
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Czakó L. , Kovács G. , Orbán-Szilágyi Á. , Pakodi F. , Patai Aim: Review of post-ERCP complications in our department
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Á. , Szepes Z. , Gyökeres T. , Fejes R. , Dubravcsik Z. , and measure the effectiveness of rectal indomethacin in
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Vincze Á. profilaxis of post-ERCP pancreatitis(PEP).
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1. Institute for Translational Medicine, Szentágothai Methods: A retrospective study was condunted in our
Research Center, Medical School, University of Pécs, Pécs, department by patients had ERCP between 2012 and
Hungary; 2. Division of Gastroenterology, First Department 2017.We investigated the applied technique,the discovered
of Medicine, Medical School, University of Pécs, Pécs, diagnose and the possibly appeared complications.We
Hungary; 3. Second Department of Medicine, University of analysed separately the group of patients where we used
Debrecen, Debrecen, Hungary; 4. Department of 100mg rectal indomethacin before the examination(Group I.)
Gastroenterology, Medical Centre Hungarian Defence and the group of patients who did not get profilaxis(Group II.).
Forces, Budapest, Hungary; 5. First Department of Medicine, Results: We performed 508 ERCP.Eight people were
University of Szeged, Szeged, Hungary; 6. First Department excluded because the papilla was not accessible with
of Gastroenterology and Medicine, Markusovszky University endoscopy.The results of 500 examinations were
Teaching Hospital, Szombathely, Hungary; 7. First evaluated:244 examinations in the group I. and 256
Department of Medicine, Szent György University Teaching examinations in group II.In the group I. PEP developed in 7
Hospital of County Fejér, Székesfehérvár, Hungary; 8. Bács- patients(2,88%).All of them was mild,severe PEP was not
Kiskun County University Teaching Hospital, Kecskemét, appeared.In the group II. we found 18 PEP(7,00%),17
Hungary patients(6,64%) with mild and 1 patient(2,88%) with severe
PEP.
Introduction:The use of advanced biliary cannulation In course of our examinations we found 5
methods carries a higher risk of post-ERCP pancreatitis in a cases(1,00%)where second endoscopy and endoscopic
setting of difficult biliary access. Cannulation technique haemostasis was needed.From these cases there was only
choice and the application of PEP prevention strategies are 1(0,20%) where transfusion was needed.Besides these
key to avoid complications. complications we found 1 case(0,20%) with other
Aims: Data from the Hungarian ERCP Registry was complication(subcutaneous emphysema).
analyzed to show the real-world practice in 7 Hungarian From our results we highlight our 98,8% papilla canullation
tertiary centers. rate,our 87% EST rate,and our needle-knife papillotomy rate
Methods: 1871 native papilla cases were identified with with4,6 %.
biliary indications. In 756 cases, advanced cannulation Conclusion:Indomethacin administered before ERCP did
methods were applied. Successful biliary cannulation rate, prove in preventing PEP.We have found significant
PEP and bleeding rate, PEP prophylaxis method use and difference between the two groups.Comparing our
cannulation times were compared. complications rate to international data we found that our
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Central European Journal of Gastroenterology and Hepatology 77
Volume 6, Supplementum 2 / November 2020